DOI: 10.36347/sjams.2014.v02i01.0106

Pages: 495-501

Background: Cardiac valve surgery performed under cardiopulmonary bypass (CPB) triggers a systemic inflammatory response that significantly contributes to postoperative morbidity. The anesthetic technique employed may modulate this inflammatory cascade and the extent of myocardial injury. Objectives: To compare the perioperative inflammatory response (IL-6, TNF-α, CRP) and myocardial injury markers (Troponin-I, CK-MB) among patients undergoing cardiac valve surgery under three different anesthetic techniques: general anesthesia (GA) alone, regional anesthesia (RA) with thoracic epidural alone, and a combination (GA+RA). Methods: This prospective observational study enrolled 30 adult patients scheduled for elective cardiac valve surgery at the Department of Anesthesia, Alluri Sitarama Raju Academy of Medical Sciences, Eluru, Andhra Pradesh, from March 2013 to December 2013. Patients were divided into three groups of 10 each: Group I (GA alone), Group II (RA alone), and Group III (GA+RA combination). Serum inflammatory markers and myocardial injury biomarkers were measured at baseline, post-CPB, and at 6, 24, and 48 hours postoperatively. Results: Group III (GA+RA) demonstrated significantly lower levels of IL-6, TNF-α, and CRP at all postoperative time points compared to Groups I and II (p < 0.001). Troponin-I and CK-MB were also significantly lower in Group III post-CPB and at 6 hours (p < 0.001). ICU stay, ventilation duration, and hospital stay were shortest in the combined technique group. Conclusion: The combination of general anesthesia with thoracic epidural analgesia significantly attenuates the systemic inflammatory response and myocardial injury associated with cardiac valve surgery under CPB, with favorable clinical outcomes. This combined technique may offer cardioprotective advantages and should be considered as a preferred approach in eligible patients.